Per Diem Pharmacist- Prior Authorization
EmpiRx Health [https://www.empirxhealth.com/] is the leading clinically-driven
pharmacy benefits management company. As the pioneer in value-based pharmacy
care, EmpiRx Health puts its customers and members first by enabling them to
take control of their pharmacy benefits, healthcare outcomes, and financial
results.
We place more emphasis on member care than any other PBM by focusing on health
outcomes first. Our pharmacists and clinicians are at the center of everything
we do―and our population health solution delivers tailored strategies for our
clients. Leveraging our newly launched, AI-powered pharmacy care platform,
Clinically [https://clinically.co/]™, EmpiRx Health’s pharmacists and client
experience teams provide the highest quality pharmacy care to our clients and
their members. This enables benefits plan sponsors to keep their members
healthy, happy, and productive, while substantially reducing prescription drug
spending, which has been on an explosive growth trajectory in recent years.
In this critical role, the Per Diem Pharmacist ensures clinical prior
authorization and appeal determinations are completed in accordance with covered
plan design while delivering clinically appropriate pharmacy care and driving
sustainable clinical savings for clients. The pharmacist supports EmpiRx
Health’s Population Health Management model through collaboration,
evidence-based decision-making, and proactive engagement with providers.
Key Responsibilities:
Clinical Review & Determinations
* Act as a clinical expert on prior authorization review and evaluation in
accordance with clinical criteria and covered plan design.
* Review, evaluate, and resolve all assigned clinical reviews through
comprehensive case review and direct physician engagement aligned with EmpiRx
Health’s Population Health Management model.
* Perform peer-to-peer reviews with providers as needed or when requested.
* Convey clinical determinations promptly within established turnaround time
requirements to prescribers, members, and healthcare professionals following
established approval and denial protocols.
Clinical Oversight & Quality Assurance
* Monitor and proactively identify clinical interventions to ensure clinical
savings guarantees are met.
* Review and evaluate current clinical literature to support recommendations
and decision-making.
* Participate in continuous quality improvement initiatives to streamline
clinical review processes and enhance member care.
* Stay informed on EmpiRx Health formulary updates, clinical programs, and
internal policies.
Collaboration & Communication
* Provide guidance and support to members, providers, and other healthcare
professionals regarding clinical inquiries.
* Collaborate with clinical technicians and prior authorization team members to
facilitate clinical review requests, resolve escalations, and answer
inquiries.
* Act as a clinical resource for internal staff, supporting staff training and
development as needed.
Technology & Documentation
* Proficiently utilize pharmacy management software for case documentation and
communications.
* Proficiently utilize Microsoft Office tools to support analysis and
reporting.
* Utilize external clinical and drug information resources (e.g., IPD, Policy
Reporter, UpToDate, MediSpan) to support reviews, decisions, and awareness of
emerging drugs.
* Collaborate cross-functionally with internal clinical teams for claim/data
review, clinical interventions, and provider/member/client support as
required.
Qualifications & Requirements
Education
Pharm.D. degree from an accredited college of pharmacy (Required).
Experience
* Minimum of 3 years of pharmacy experience in clinical, PBM, or managed care
settings.
* Prior experience with prior authorization, utilization management, or health
plan operations preferred.
Licensure/Certifications
* Active Pharmacist License in good standing (Required).
Skills & Competencies
* Strong clinical judgment and analytical thinking skills.
* Exceptional written and verbal communication.
* High attention to detail and accuracy in documentation.
* Excellent organizational and multitasking abilities.
* Proficient in Microsoft Office Suite and pharmacy systems.
* Ability to work independently and collaboratively in a fast-paced
environment.
Work Environment: Remote
Benefits And Perks
Subject to program eligibility, this position qualifies for a robust suite of
benefits including: Paid Time Off, a 401(k) program, Health Insurance including
Dental & Vision coverage, Student Loan Reimbursement, Health Savings Account,
and an Employee Assistance Program.
EmpiRx Health is an Equal Opportunity Employer
At EmpiRx Health, we wholeheartedly embrace the power of diversity and the magic
of inclusion. The kaleidoscope of unique perspectives, backgrounds, and talents
fuels our innovation and sets us apart. We're on a mission to build a team as
diverse as the world we serve, where everyone is welcome and celebrated. We're
not just breaking down barriers; we're actively erasing them to create an
environment where opportunity knows no bounds. In unity, we find our strength
and invite individuals from all walks of life to join us in our exhilarating
journey to shape a brighter, more inclusive future together.
Note: This job description is a general outline of responsibilities and
qualifications for the role. Additional duties may be assigned, and the position
may evolve to meet the organization's needs.